The purpose of the study was to analyze literature sources examining current views on the relationship between obstructive sleep apnea syndrome and obesity in order to improve physicians' awareness of potential risks, enhance diagnostics of obstructive sleep apnea syndrome, timely prescribe appropriate treatment and improve the prognosis for such patients. Materials and methods. We conducted a review and analysis of scientific and medical literature relying on databases Scopus, Web of Science, MedLine, and PubMed. Results and discussion. In recent years, scientists have focused on the problem of obstructive sleep apnea syndrome. On the one hand, this is due to the high prevalence of obstructive sleep apnea syndrome, which, according to literature, is almost one billion people worldwide and significantly burdens people and society. On the other hand, obstructive sleep apnea syndrome is currently considered a significant, potentially modified risk factor for cardiovascular disease, including coronary heart disease, heart failure, acute and chronic forms of vascular pathology of the brain. A well-known criterion for the severity of obstructive sleep apnea syndrome is the frequency of respiratory pauses per hour – apnea / hypopnea index. The results indicate that it is after 5 respiratory pauses for each hour of sleep when the severity of clinical symptoms characteristic of obstructive sleep apnea syndrome occurs and gradually progresses. With an apnea / hypopnea index of more than 15, the risk of cardiovascular and metabolic disorders increases, and with an apnea / hypopnea index of more than 30 per hour, the risk of adverse, including fatal, cardiovascular consequences is significant. The etiology of obstructive sleep apnea syndrome is multifactorial, involving complex interactions between anatomical, neuromuscular factors, and genetic predisposition. One of the most common satellites of sleep apnea is overweight and obesity. Currently, obesity is considered one of the most significant medical, social and economic problems in the world due to its high frequency of representation in the population and significant costs for the treatment of its consequences. According to the 2019 STEPS study, in Ukraine, only two-fifths (39.6%) of the population are normal weight, and almost three-fifths (59.1%) are overweight and obese. Conclusion. Thus, it is of clinical importance to select groups of patients with obstructive sleep apnea syndrome in the comorbid association with obesity, which will help identify diagnostically significant indicators, develop the algorithms for predicting the course of the disease, and elaborate the targeted approaches to preventing complications

Keywords: obstructive sleep apnea syndrome, apnea / hypopnea index, comorbidity, overweight, obesity

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1. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7:687-98. https://doi.org/10.1016/S2213-2600(19)30198-5
2. Yasir M, Pervaiz A, Sankari A. Cardiovascular Outcomes in Sleep-Disordered Breathing: Are We Under-estimating? Front Neurol. 2022;13:801167. PMID: 35370882. PMCID: PMC8965583. https://doi.org/10.3389/fneur.2022.801167
3. Mostbauer HV.  Ishemichna khvoroba sertsya i syndrom obstruktyvnoho apnoe snu [Ischemic heart disease and obstructive sleep apnea syndrome]. 2022. [Ukrainian]. Available from: https://health-ua.com/article/69109-shemchna-hvoroba-sertcya--sindrom-obstruktivnogo-apnoe-snu
4. Roca GQ, Redline S, Claggett B, Bello N, Ballantyne CM, Solomon SD, et al. Sex-specific association of sleep apnea severity with subclinical myocardial injury, ventricular hypertrophy, and heart failure risk in a community-dwelling cohort: the Atherosclerosis risk in communities-sleep heart health study. Circulation. 2015;132:1329-37. PMID: 26316620. PMCID: PMC4596785. https://doi.org/10.1161/CIRCULATIONAHA.115.016985
5. Chan A. Mechanism of sudden cardiac death in obstructive sleep apnea. Sleep Medicine. 2013;14(10):e95. https://doi.org/10.1016/j.sleep.2013.11.201
6. Kryvenko VI, Svitlytsʹka OA. Kardiovaskulyarni porushennya u viddili z poyednanym perebihom obstruktyvnoho apnoho snu ta hastroezofahealʹnoyi reflyuksnoyi khvoroby [Cardiovascular disorders in patients with combined course of obstructive sleep apnea and gastroesophageal reflux disease]. ScienceRise. 2020;1(34):18-22. [Ukrainian]. https://doi.org/10.15587/2519-4798.2020.192702
7. Trybrat TA, Shutʹ SV, Sakevych VD. Metabolichnyy syndrom v praktytsi simeynoho likarya [Metabolic syndrome in the practice of a family doctor]. Visnyk problem biolohiyi i medytsyny. 2015;4(121):36-38. [Ukrainian]
8. Marshall NS, Wong KKH, Liu PY, Cullen SRJ, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: The Busselton Health Study. SLEEP. 2008;31(8):1079-1085.
9. Jun JC, Chopra S, Schwartz AR. Sleep apnoea. Eur Respir Rev. 2016;25(13):12-18. PMID: 26929416. PMCID: PMC5686780. https://doi.org/10.1183/16000617.0077-2015
10. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479-504. PMID: 28162150. PMCID: PMC5337595. https://doi.org/10.5664/jcsm.6506
11. Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773-827. PMID: 26094920. PMCID: PMC4481062. https://doi.org/10.5664/jcsm.4858
12. Marshall NS, Wong KK, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton health study cohort. J Clin Sleep Med. 2014;10(4):355-362. PMID: 24733978. PMCID: PMC3960375. https://doi.org/10.5664/jcsm.3600
13. Drager LF, McEvoy RD, Barbe F. Lorenzi-Filho G. Sleep Apnea and Cardiovascular Disease: Lessons From Recent Trials and Need for Team Science. Circulation. 2017;136(19):1840-1850. PMID: 29109195. PMCID: PMC5689452. https://doi.org/10.1161/CIRCULATIONAHA.117.029400
14. Malhotra A, Orr JE, Owens RL. On the cutting edge of obstructive sleep apnoea: where next? Rapid Review. 2015;3:397-402. https://doi.org/10.1016/S2213-2600(15)00051-X
15. Sankri-Tarbichi AG. Obstructive sleep apnea-hypopnea syndrome: Etiology and diagnosis. Avicenna J Med. 2012;2(1):3-8. PMID: 23210013. PMCID: PMC3507069. https://doi.org/10.4103/2231-0770.94803
16. Ralls FM, Grigg-Damberger M. Roles of gender, age, race/ethnicity, and residential socioeconomics in obstructive sleep apnea syndromes. Curr Opin Pulmon Med. 2012;18(6):568-573. PMID: 22990656. https://doi.org/10.1097/MCP.0b013e328358be05
17. Priyadarshan S, Shrinath DKP. Etiology of obstructive sleep apnoea syndrome. Int J Otorhinolaryngol Head Neck Surg. 2017;3:952-6. https://doi.org/10.18203/issn.2454-5929.ijohns20174313
18. Knorst MM, Souza FJ, Martinez D. Obstructive sleep apnea-hypopnea syndrome: association with gender, obesity and sleepiness-related factors. J Brasil Pneumonol. 2008;34(7):490-6.
19. Canto GL, Pachêco-Pereira C, Aydinoz S, Major PW, Flores-Mir C, Gozal D. Biomarkers associated with obstructive sleep apnea: A scoping review. Sleep Med Rev. 2015;23:28-45. PMID: 25645128. PMCID: PMC4447611. https://doi.org/10.1016/j.smrv.2014.11.004
20. World Health Organization Media Centre. Obesity and overweight. Fact sheet no Geneva: World Health Organization; 2021. Available from: https://www.who.int/ru/news-room/fact-sheets/detail/obesity-and-overweight
21. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766-781. https://doi.org/10.1016/S0140-6736(14)60460-8
22. Shut SV, Trybrat ТА, Ivanytska TA, Goncharova OO, Katrychenko LO. The public awareness of overweight and obesity as a risk factor for cardiovascular diseases. Med Ecolog Probl. 2020;24(3-4):15-18. https://doi.org/10.31718/mep.2020.24.3-4.04
23. Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019;92:6-10. PMID: 30253139. https://doi.org/10.1016/j.metabol.2018.09.005
24. Bakker JP, Weng J, Wang R, Redline S, Punjabi NM, Patel SR. Associations between obstructive sleep apnea, sleep duration, and abnormal fasting glucose. The multi-ethnic study of atherosclerosis. Am J Respir Crit Care Med. 2015;192(6):745-753. PMID: 26084035. PMCID: PMC4595677. https://doi.org/10.1164/rccm.201502-0366OC
25. Scarpina F, Marzullo P, Mai S, Mauro A, Scacchi M, Costantini M. Altered temporal sensitivity in obesity is linked to pro-inflammatory state. Sci Rep. 2019;9(1):15508. PMID: 31664059. PMCID: PMC6820747. https://doi.org/10.1038/s41598-019-51660-5
26. Gharraf HS, AlHadidy A, AlNehr I. Study of leptin and ghrelin serum levels in patients with obstructive sleep apnea. Egypt J Chest Dis Tuberc. 2019;68:567-74. https://doi.org/10.1183/13993003.congress-2020.2125
27. Boing S, Randerath WJ. Chronic hypoventilation syndromes and sleep-related hypoventilation. J Thorac Dis. 2015;7(8):1273-1285.
28. Marshall NS, Wong KК, Cullen SR J, Knuiman MW Grunstein RR. Sleep Apnea and 20-Year Follow-Up for All-Cause Mortality, Stroke, and Cancer Incidence and Mortality in the Busselton Health Study Cohort. J Clin Sleep Med. 2014;10(4):355-62. PMID: 24733978. PMCID: PMC3960375. https://doi.org/10.5664/jcsm.3600
29. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D. Nieto FJ. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071-1078.
30. Gami AS, Somers VK. Sudden death and obstructive sleep apnea. Electrical Diseases of the Heart: Genetics, Mechanisms, Treatment, Prevention. London UK: Springer; 2007. 941 p.
31. Mokhlesi B, Finn LA, Hagen EW, Young T, Hla KM, Cauter EV, et al. Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort. Am J Respir Crit Care Med. 2014;190(10):1158-1167. PMID: 25295854. PMCID: PMC4299639. https://doi.org/10.1164/rccm.201406-1136OC
32. Gami AS, Olson EJ, Shen WK, Wright RS, Ballman KV, Hodge DO, et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am Coll Cardiol. 2013 Aug 13;62(7):610-6. PMID: 23770166. PMCID: PMC3851022. https://doi.org/10.1016/j.jacc.2013.04.080
33. Nakaz Ministerstva okhorony zdorov'ya Ukrayiny 24.05.2012 № 384. Unifikovanyy klinichnyy protokol pervynnoyi, ekstrenoyi ta vtorynnoyi (spetsializovanoyi) medychnoyi dopomohy [Unified clinical protocol of primary, emergency and secondary (specialized) medical care]. Available from: https://zakononline.com.ua/documents/show/67431___67431. https://doi.org/10.4236/jbise.2012.51004
34. Mashaqi S, Badr MS. The impact of obstructive sleep apnea and positive airway pressure therapy on metabolic peptides regulating appetite, food intake, energy homeostasis, and systemic inflammation: a literature review. J Clin Sleep Med. 2019;15(7):1037-1050. PMID: 31383242. PMCID: PMC6622519. https://doi.org/10.5664/jcsm.7890